Provider Demographics
NPI:1477833564
Name:RODRIGUEZ-DIFFUT, MARJORIE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:
Last Name:RODRIGUEZ-DIFFUT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE PIRANDELLO URB. PURPLE TREE
Mailing Address - Street 2:# 517
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-367-8539
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION PURPLE TREE CALLE PIRANDELLO
Practice Address - Street 2:517
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-367-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical